Hypertension

August 15, 2011

Considerable data from epidemiological studies support a link between hypertension (high blood pressure) and atherosclerosis. This makes hypertension the most prevalent of risk factors with over 80 million Americans defined as having high blood pressure (traditionally defined as a reading of 140/90 mm Hg as measured with a blood pressure cuff). Prevalence of hypertension is higher in men than in women until age 60 at which time it becomes more prevalent in women. This fact combined with the longer life expectancy of women leads to a higher number of hypertensionrelated complications in women than in men after age 65. In addition to increasing the risk of coronary atherosclerosis, hypertension also increases the risk of stroke and heart failure. Data from another landmark medical study, the Framingham study, show that hypertension causes more strokes in women than men (59% vs. 39%). The same study also showed that women with hypertension are more likely than their male counterparts to develop congestive heart failure (hazard ratio 3.21:2.04). Control of blood pressure with medications appears to reduce the risk of subsequent cardiovascular events. Initial medical studies of antihypertensive treatments clearly demonstrated a benefit of treatment in men as well as elderly women with insignificant effect in younger women, particularly white women. This was likely because most trials did not include sufficient numbers of women to come to a reliable conclusion. In fact, 3 of the 10 major older clinical trials (a type of medical study) excluded women. It was not until more recent studies that clear benefit for women was demonstrated. The Treatment of Mild Hypertension Study (TOMHS) studied 557 men and 345 women aged 45-69 with mild hypertension. Treatment resulted in equal risk reduction of major cardiovascular clinical events in women and men. Similar results were obtained from the large Systolic Hypertension in the Elderly Program (SHEP) trial.